title: China's health system performance.
abstract: We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their effect on performance indicators, for which substantial data gaps exist.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA. Electronic address: yuanliu@hsph.harvard.edu.
authors.forename: Yuanli
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Ministry of Health, Beijing, China.
authors.forename: Keqin
authors.initials: K
authors.lastname: Rao
authors.affiliation: Ministry of Health, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wu
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
mesh_terms: D002662:Child Health Services / Q000191:economics / Q000639:trends; D002675:Child, Preschool; D002681:China; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration* / Q000639:trends; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000191:economics / Q000639:trends; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D019037:Urban Health Services / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends